Provider Demographics
NPI:1285342303
Name:BORGMAN, MADISON ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ANNE
Last Name:BORGMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 INWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-0014
Mailing Address - Country:US
Mailing Address - Phone:214-645-1482
Mailing Address - Fax:214-645-3301
Practice Address - Street 1:1801 INWOOD ROAD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-0014
Practice Address - Country:US
Practice Address - Phone:214-645-1482
Practice Address - Fax:214-645-3301
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16754363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant